A Room Without a View: Toward the Evidence

Bronchiolitis is 1 of the most common causes of pediatric hospitalization and accounts for >$1.7 billion in hospital charges annually.1 The history of management of bronchiolitis in infants is a study in the reduction of unnecessary resources. Early in treating this disease, routine testing and ineffective therapies were common. Many of us recall the days of ubiquitous chest radiography, complete blood cell counts, albuterol, racemic epinephrine, and steroids. Many recall average lengths of stay of 5 days rather than perhaps 2.5 now. We have not entirely gotten away from that history. Although data show a lack of efficacy of these therapies and guidelines have reduced use, overtesting and overuse of interventions remain common.2 And we continue to employ new therapies before evidence demonstrates efficacy. For example, the use of high-flow nasal cannula has not been shown to impact length of stay or any resource use other than use of high-flow nasal cannula, yet we continue to broadly adopt it in the United States without robust evidence demonstrating benefit.3,4 Although there have been considerable efforts to …